Simply Healthcare Plans
Also covers / subsidiaries: Simply, SMH, Simply Healthcare
Core Payer & Clearinghouse Profile
Electronic Payer ID
SMPLY
Alpha ID SMPLY on Claim.MD; legacy numeric IDs (00199, 27094) seen and vary by clearinghouse — verify.
Timely Filing Limit (TFL)
~90 days from DOS for full payment, with a 50% reduction for claims filed 3–6 months out — verify against current FL Medicaid provider manual (which may state 180 days)
Appeal Window
Varies — confirm via portal / clearinghouse
Clearinghouse Gateway
Availity Essentials (mandated EDI gateway)
Provider Services
844-405-4296
Claims Fax
Varies — confirm via portal / clearinghouse
Claims Address
Varies — confirm via portal / clearinghouse
Provider Portal
https://provider.simplyhealthcareplans.com/florida-provider/home
Elevance/Anthem-owned. The 90-day-for-full-payment rule with a 50% reduction window is an outlier — verify. Absorbed former Vivida (Region 8) and Lighthouse (Regions 1-2) Medicaid members.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for Simply Healthcare Plans.
Associated Clearinghouse Payer IDs
National clearinghouse networks maintain dedicated routing IDs for specific transaction lines or subsidiaries under Simply Healthcare Plans.
| Clearinghouse Name | Electronic Payer ID | Status | Enrollment | Supported Services |
|---|---|---|---|---|
| Simply Healthcare | SMPLY | Non-Par | Required | 837P837I835 ERA |
| Simply Healthcare Plans | 10826 | Par | None | 837P837I270/271276/277Dental |
Resolution Tools for Simply Healthcare Plans Claims
Values vary by plan, line of business, and provider agreement. Confirm in the payer portal or with your clearinghouse gateway before submitting electronic claims.
Tired of Chasing Simply Healthcare Plans Denials & Delayed Payments?
Aethera's billing specialists work Simply Healthcare Plans every day — handling EDI clearinghouse rejects, prior authorizations, payment posting, and 30-day AR aging recovery.